CN112842454B - A guide for osteotomy around the knee joint and its application - Google Patents
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Abstract
Description
Translated fromChinese技术领域technical field
本发明属于辅助医疗器械技术领域，更具体地涉及一种用于膝关节周围截骨的导向器及其应用。The invention belongs to the technical field of auxiliary medical devices, and more particularly relates to a guide for osteotomy around a knee joint and its application.
背景技术Background technique
单髁膝关节病变是指在膝关节的三个间室中，膝关节骨性关节炎的特点是一个间室受累严重，其他两个间室轻度受累或病变发展缓慢，而受累严重的大部分为内侧间室。在膝关节骨性关节炎的患者中内侧间室单独受累者约占25％，而外侧间室受累者仅占5％。单髁膝关节病变治疗方式分非手术治疗(药物治疗、矫形鞋垫、膝关节支具)和手术治疗(关节镜清扫、截骨术、单髁膝关节置换UKA、全膝关节置换TKA)。其中，截骨术又分为开放楔形截骨术、闭合楔形截骨术和腓骨截骨术。不论是闭合楔形截骨术还是开放楔形截骨术都需要考虑截骨合页位置的正确性、截骨面的平整性以及合页的完整性。OWHTO—开放楔形胫骨高位截骨术为不全截骨，具有以下优点：技术简单，切口损伤小，畸形矫正精确，术中力线调整方便。由于膝关节内侧间室高应力传导，需要采取适当方法维持胫骨结构的稳定。该手术成功的关键在于：适合的患者选择、安全准确的手术技术和可靠的内固定。Unicondylar knee joint disease refers to the three compartments of the knee joint. Knee osteoarthritis is characterized by severe involvement of one compartment, mild involvement of the other two compartments or slow progression of the disease, and severe involvement of large. Part of the medial compartment. About 25% of patients with knee osteoarthritis have medial compartment involvement alone, while only 5% have lateral compartment involvement. The treatment methods of unicondylar knee joint lesions are divided into non-surgical treatment (drug therapy, orthopedic insole, knee brace) and surgical treatment (arthroscopic dissection, osteotomy, unicondylar knee joint replacement UKA, total knee joint replacement TKA). Among them, osteotomy is further divided into open wedge osteotomy, closed wedge osteotomy and fibula osteotomy. Whether it is a closed wedge osteotomy or an open wedge osteotomy, the correctness of the position of the osteotomy hinge, the flatness of the osteotomy surface, and the integrity of the hinge need to be considered. OWHTO—Open Wedge High Tibial Osteotomy is an incomplete osteotomy, which has the following advantages: simple technique, less incision damage, accurate deformity correction, and easy adjustment of intraoperative alignment. Due to the high stress conduction in the medial compartment of the knee joint, appropriate measures are required to maintain the stability of the tibial structure. The key to the success of this operation is: appropriate patient selection, safe and accurate surgical technique and reliable internal fixation.
其中，安全准确的手术技术需结合术前影像学检查、术前规划、截骨前透视打入克氏针、设计截骨位置，最后进行截骨。可靠的内固定通常采用T 型加压锁定钢板来实现。克氏针也被称为骨圆针，作为骨科常用的内固定材料在截骨矫形时作为临时固定器和截骨面位置确定器。术中为了能将2根克氏针打入满意的截骨位置，应尽量保证2根克氏针处在同一截骨平面上，因此，临床医生需要在X线反复透视下确定2根克氏针的插入位置。这样做不仅使手术时间延长，而且医生和患者受到大量X线辐射伤害。同时，即使经过多次X线透视定位，克氏针最终的理想位置也无法精确确定，只能通过临床医生在钻入克氏针时凭手感和经验确定，钻入深度也没有直观测量数据为手术提供支持。此外，在沿着2根克氏针下方行截骨术时，经常遇到克氏针松动或脱落的现象，导致截骨方向改变、合页断裂等问题。Among them, safe and accurate surgical techniques should be combined with preoperative imaging examination, preoperative planning, K-wire insertion before osteotomy, design of osteotomy position, and finally osteotomy. Reliable internal fixation is usually achieved with T-shaped compression locking plates. Kirschner wire, also known as bone round needle, is a commonly used internal fixation material in orthopaedics as a temporary fixator and a position determiner for the osteotomy surface during osteotomy and correction. In order to drive the two Kirschner wires into a satisfactory osteotomy position during the operation, it is necessary to ensure that the two Kirschner wires are on the same osteotomy plane. Therefore, the clinician needs to determine the two Kirschner wires under repeated X-ray fluoroscopy. needle insertion position. Doing so not only prolongs the operation time, but also exposes doctors and patients to a large amount of X-ray radiation. At the same time, even after multiple X-ray fluoroscopy positioning, the final ideal position of the Kirschner wire cannot be accurately determined. It can only be determined by the clinician's hand and experience when drilling the Kirschner wire. There is no intuitive measurement data for the drilling depth. Surgery provides support. In addition, when performing osteotomy along the lower part of the two Kirschner wires, the Kirschner wires are often loosened or fallen off, resulting in changes in the direction of the osteotomy and broken hinges.
在如下文献中，还可以发现更多与上述技术方案相关的信息。中国实用新型专利CN210330665U“一种用于膝关节前交叉韧带损伤重建的定位骨隧道装置”公开了一种用于膝关节前交叉韧带损伤重建的定位骨隧道装置，包括导钻套、瞄准器把手和瞄准器，所述导钻套能据X-Y做直线滑动的连接在瞄准器把手的底座上，所述瞄准器能滑动的连接在弧形滑轨上。中国实用新型专利CN211534656U“一种膝关节周围截骨辅助定位导向器”公开了一种膝关节周围截骨辅助定位导向器，包括一端设有弧形滑轨的固定杆和一端设有与所述弧形滑轨相匹配的滑块的定位杆，所述定位杆通过所述滑块与所述固定杆的弧形滑轨可滑动式连接；所述滑块的顶端设有用于将所述滑块固定于所述弧形滑轨上的第一紧固螺钉。More information related to the above technical solutions can also be found in the following documents. Chinese utility model patent CN210330665U "A positioning bone tunnel device for reconstruction of anterior cruciate ligament injury of knee joint" discloses a positioning bone tunnel device for reconstruction of anterior cruciate ligament injury of knee joint, including a drill guide sleeve and a sight handle and the sight, the drill guide sleeve can be slidably connected to the base of the sight handle according to X-Y, and the sight can be slidably connected to the arc-shaped slide rail. Chinese utility model patent CN211534656U "An auxiliary positioning guide for osteotomy around the knee joint" discloses an auxiliary positioning guide for osteotomy around the knee joint, which includes a fixed rod with an arc-shaped slide rail at one end and a The positioning rod of the sliding block matched with the arc-shaped sliding rail, the positioning rod is slidably connected with the arc-shaped sliding rail of the fixing rod through the sliding block; The block is fixed on the first fastening screw on the arc-shaped slide rail.
发明内容SUMMARY OF THE INVENTION
鉴于背景技术存在的上述技术问题，需要提供一种用于膝关节周围截骨的导向器及其应用，所述用于膝关节周围截骨的导向器在临床应用中需能大大减少X线透视的次数以降低医生和患者的X线暴露损伤，在减少X线透视次数的条件下还能精确定位截骨线位置，进一步地，还可以解决现有技术在截骨操作时克氏针发生松动，截骨线移位、截骨面倾斜的问题。In view of the above-mentioned technical problems existing in the background art, it is necessary to provide a guide for osteotomy around the knee joint and its application. In order to reduce the X-ray exposure damage of doctors and patients, the position of the osteotomy line can be accurately positioned under the condition of reducing the number of X-ray fluoroscopy, and further, it can also solve the loosening of the Kirschner wire during the osteotomy operation in the prior art. , the displacement of the osteotomy line and the inclination of the osteotomy surface.
为实现上述目的，在本发明的第一方面，发明人提供了一种用于膝关节周围截骨的导向器，包括定位器和导板，In order to achieve the above object, in the first aspect of the present invention, the inventor provides a guide for osteotomy around the knee joint, including a locator and a guide plate,
所述定位器包括定位底座、定位支架、定位前臂、定位后臂、定位杆和定位钩；The positioning device includes a positioning base, a positioning bracket, a positioning forearm, a positioning rear arm, a positioning rod and a positioning hook;
所述定位支架的一端与所述定位底座固定连接，所述定位支架的另一端与所述定位前臂的一端活动连接，所述定位前臂的另一端与所述定位后臂的一端固定连接，所述定位后臂的另一端与所述定位杆的一端固定连接，所述定位杆的另一端与所述定位钩固定连接，其中，所述定位支架的另一端上设置有滑轨，用于所述定位前臂的一端与其滑动连接；One end of the positioning bracket is fixedly connected with the positioning base, the other end of the positioning bracket is movably connected with one end of the positioning forearm, and the other end of the positioning forearm is fixedly connected with one end of the positioning rear arm. The other end of the positioning rear arm is fixedly connected with one end of the positioning rod, and the other end of the positioning rod is fixedly connected with the positioning hook, wherein the other end of the positioning bracket is provided with a slide rail for all One end of the positioning forearm is slidably connected with it;
所述定位底座上沿着指向所述定位杆方向平行钻设有第一套筒孔和第二套筒孔。A first sleeve hole and a second sleeve hole are drilled in parallel on the positioning base along the direction pointing to the positioning rod.
本发明提供的导向器中，定位支架和定位前臂可以是带有一定弧度的圆弧，也可以是直线段，但定位支架和定位前臂之间是互相适配的滑动结构。当定位支架和定位前臂是相适配直线段的时候，定位支架、定位前臂、定位后臂和定位杆形成了“匚”字型，随着套筒的推进，使本发明导向器的定位器不断接近一个长方形、正方形或圆角长方形/正方形形态，此时通过长方形的宽或正方形的边长长度和推进的套筒长度就可以计算出需要打入的克氏针长度。当定位支架和定位前臂是相适配的圆弧的时候，套筒与定位底座的接触点到定位钩之间的距离即为圆弧的半径，通过滑动定位前臂调整定位器与待截骨位置的卡合，通过半径和推进套筒的长度计算出需要打入克氏针的长度。与传统方法相比，大大减少打入克氏针的X透视次数并提高了打入深度的精确度。本发明提供的导向器适用于膝关节周围截骨术中包括胫骨近端高位截骨和股骨远端截骨。通过定位支架可以准确将克氏针打入到合页位置(胫骨近端高位截骨合页位置位于腓骨尖端上三分之一，股骨远端截骨合页位置位于干骺端交叉点)，计算出需要截骨的深度后(即需打入的克氏针长度)，将所述导板套入克氏针，就可以确定截骨方向、深度，保证截骨面的平整性，实现精准截骨和快速截骨目的。整个操作简单、方便，容易在临床上推广。In the guide provided by the present invention, the positioning bracket and the positioning forearm may be arcs with a certain radian, or may be straight segments, but the positioning bracket and the positioning forearm are mutually matched sliding structures. When the positioning bracket and the positioning forearm are matched to the straight line segment, the positioning bracket, the positioning forearm, the positioning rear arm and the positioning rod form a "匚" shape. With the advancement of the sleeve, the positioning device of the guide of the present invention Continue to approach a rectangle, square or rounded rectangle/square shape. At this time, the length of the K-wire that needs to be inserted can be calculated by the width of the rectangle or the length of the side of the square and the length of the advanced sleeve. When the positioning bracket and the positioning forearm are arcs that match, the distance between the contact point of the sleeve and the positioning base to the positioning hook is the radius of the arc. By sliding the positioning forearm to adjust the positioning device and the position to be osteotomy The length of the K-wire that needs to be inserted is calculated from the radius and the length of the push sleeve. Compared with traditional methods, the number of X-rays for K-wire insertion is greatly reduced and the accuracy of insertion depth is improved. The guide provided by the present invention is suitable for the osteotomy around the knee joint, including the high osteotomy of the proximal tibia and the osteotomy of the distal femur. The Kirschner wire can be accurately driven into the hinge position by positioning the bracket (the proximal tibial high osteotomy hinge position is located in the upper third of the tip of the fibula, and the distal femoral osteotomy hinge position is located at the metaphyseal junction), After calculating the depth of osteotomy required (that is, the length of the Kirschner wire to be driven), insert the guide plate into the Kirschner wire to determine the direction and depth of the osteotomy, ensure the flatness of the osteotomy surface, and achieve accurate cutting. Bone and rapid osteotomy purposes. The whole operation is simple and convenient, and it is easy to be popularized in clinic.
现在传统的开放楔形截骨术的实施一般包含以下步骤：The implementation of the traditional open wedge osteotomy today generally involves the following steps:
一、术前影像学检查1. Preoperative imaging examination
1、双下肢负重全长片；1. Weight-bearing full-length film of both lower extremities;
2、膝关节负重正位片；2. Knee joint weight-bearing anteroposterior film;
3、髌骨切线位片；3. Patella tangent film;
4、屈膝30°Tunnel位片；4. Knee flexion 30°Tunnel position film;
5、屈膝45°Rosenburg位片。5. Rosenburg position film with knee flexion 45°.
二、截骨前透视打入克氏针2. K-wire insertion before osteotomy
将腿完全伸直，并在透视下调整膝关节位置直至获得完全AP位影像。在 AP位上对齐内髁与外髁。旋转腿部，直至髌骨完全位于前方(这样腓骨头的 1/3一般被胫骨覆盖)。Fully straighten the leg and adjust the position of the knee joint under fluoroscopy until a full AP image is obtained. Align the medial and lateral condyles on the AP position. Rotate the leg until the patella is fully anterior (so that 1/3 of the fibular head is generally covered by the tibia).
在透视下将2枚2.5mm克氏针打入胫骨头部，这两枚克氏针即可指示截骨方向。Under fluoroscopy, two 2.5mm K-wires were inserted into the tibial head, and the two K-wires could indicate the direction of the osteotomy.
然后再根据克氏针打入位置设计截骨位置，确定上行截骨面，进行水平截骨和上行截骨。Then, the osteotomy position is designed according to the insertion position of the Kirschner wire, and the ascending osteotomy surface is determined, and the horizontal osteotomy and ascending osteotomy are performed.
其中，克氏针是一种骨科常用的内固定材料，其原规格一般固定在二十公分左右，直径在0.5-2mm之间有不同的几种规格。用于固定短小骨折或撕脱骨折等应力不大的骨折固定，也常被用在骨科手术中临时骨折块的固定中。由于被广泛应用，克氏针的最大直径逐渐增加到4mm随着外固定支架的，配合外固定锁钉来固定骨盆骨折、跟骨骨折等应急较大的骨折。Among them, Kirschner wire is a commonly used internal fixation material in orthopaedics. It is used to fix short fractures or avulsion fractures and other fractures with little stress. It is also often used in the fixation of temporary fracture fragments in orthopaedic surgery. Due to its wide application, the maximum diameter of Kirschner wires has gradually increased to 4 mm with the addition of external fixation brackets, and external fixation locking screws can be used to fix large emergency fractures such as pelvic fractures and calcaneal fractures.
克氏针固定技巧：首先，可以用一枚克氏针固定骨折于解剖位置；然后，分别在骨折近端和远端距骨折线0.5-1厘米处垂直于指骨纵轴钻孔，过双侧骨皮质。第一枚后方克氏针应位于鹅掌上缘，胫骨后嵴前缘。第2枚克氏针应位于第一枚克氏针前方2cm处并与之平行。两个克氏针形成平面与近端关节面后倾一致。此两枚克氏针应在一个平面内、且此平面应和指骨纵轴平行。Kirschner wire fixation technique: First, a Kirschner wire can be used to fix the fracture in the anatomical position; then, drill holes perpendicular to the longitudinal axis of the phalanx at the proximal and distal ends of the fracture, 0.5-1 cm away from the fracture line, and pass bilaterally. cortical bone. The first posterior Kirschner wire should be located on the upper border of the tulip and the anterior border of the posterior tibial crest. The second K-wire should be located 2 cm in front of and parallel to the first K-wire. The plane formed by the two K-wires is consistent with the posterior inclination of the proximal articular surface. The two Kirschner wires should be in a plane, and this plane should be parallel to the longitudinal axis of the phalanx.
根据本发明示例性的实施方式，所述导板为由定位板和限位板通过手持端连接形成具有槽体的结构，所述定位板设置有第一面、第二面和第一侧面，所述限位板设置有第三面、第四面和第二侧面，所述第一面和第二面相对设置，所述第三面和第四面相对设置，所述第一侧面和第二侧面分别设置于远离所述槽体的两侧，沿所述第一面通向第二面的方向平行开设有第一定位孔和第二定位孔，所述第一定位孔和第二定位孔中心轴线之间的距离与所述第一套筒孔和第二套筒孔中心轴线之间的距离相等。由于水平截骨面是自胫骨后缘至胫骨中前1/3，紧贴克氏针。根据本发明，所述导板用于盖住确定截骨线的克氏针，这样在行截骨操作的时候，不用为了避免克氏针露出部分妨碍截骨操作而像传统方法那样将克氏针剪断，而且后续操作过程中不会导致克氏针松动移位等问题。According to an exemplary embodiment of the present invention, the guide plate is a structure with a groove body formed by connecting a positioning plate and a limiting plate through a hand-held end, and the positioning plate is provided with a first surface, a second surface and a first side surface, so The limiting plate is provided with a third surface, a fourth surface and a second side surface, the first surface and the second surface are arranged oppositely, the third surface and the fourth surface are arranged oppositely, the first side surface and the second The side surfaces are respectively arranged on both sides away from the groove body, and a first positioning hole and a second positioning hole are opened in parallel along the direction from the first surface to the second surface. The first positioning hole and the second positioning hole The distance between the central axes is equal to the distance between the central axes of the first sleeve hole and the second sleeve hole. Since the horizontal osteotomy surface is from the posterior border of the tibia to the anterior 1/3 of the tibia, it is close to the Kirschner wire. According to the present invention, the guide plate is used to cover the K-wire that defines the osteotomy line, so that during the osteotomy operation, there is no need to insert the K-wire as in the traditional method in order to prevent the exposed part of the K-wire from hindering the osteotomy operation. Cut off, and will not cause problems such as looseness and displacement of K-wires during subsequent operations.
根据本发明示例性的实施方式，沿所述第三面通向第四面的方向开设有限位通孔，用于打入限位克氏针。设置该限位通孔的作用在于保证推进截骨锯的过程中，由导板和两枚克氏针所形成的结构更加稳定，因此，优选地，所述限位通孔的数量为1个以上。According to an exemplary embodiment of the present invention, a limit through hole is opened along the direction from the third surface to the fourth surface, for driving the limit K-wire. The function of setting the limit through hole is to ensure that the structure formed by the guide plate and the two Kirschner wires is more stable during the process of advancing the osteotomy saw. Therefore, preferably, the number of limit through holes is more than one .
考虑到本发明所述导向器结构的简洁和操作步骤的便捷，根据本发明示例性的实施方式，所述限位通孔包括第一限位通孔和第二限位通孔，并且所述第一限位通孔和第二限位通孔不平行设置。之所以优选不平行设置也是基于固定结构带来的稳定作用所作的设想。可以理解，如果所述第一限位通孔和第二限位通孔的方向平行并且恰好与所述第一定位孔和第二定位孔方向一致，则由于存在同向力的作用，插入所述第一限位通孔和第二限位通孔的两枚克氏针与插入所述第一定位孔和第二定位孔的两枚克氏针很可能会发生松动，导致截骨面位置偏移。Considering the simplicity of the structure of the guide of the present invention and the convenience of the operation steps, according to an exemplary embodiment of the present invention, the limit through hole includes a first limit through hole and a second limit through hole, and the The first limiting through hole and the second limiting through hole are not arranged in parallel. The reason why the non-parallel arrangement is preferred is also based on the assumption of the stabilizing effect brought about by the fixed structure. It can be understood that if the directions of the first limit through hole and the second limit through hole are parallel and exactly the same as the direction of the first positioning hole and the second positioning hole, due to the action of the same direction force, the insertion The two K-wires in the first and second limiting through holes and the two K-wires inserted in the first and second positioning holes are likely to loosen, resulting in the position of the osteotomy surface. offset.
进一步地，所述槽体沿所述第一侧面通向第二侧面之间的距离为 5-15mm。所述槽体为截骨锯提供精确导向并约束切割的位置、方向和深度，保证截骨面的平整性，实现精准截骨和快速截骨目的。Further, the distance between the groove body leading to the second side surface along the first side surface is 5-15mm. The groove body provides precise guidance for the osteotomy saw and constrains the position, direction and depth of cutting, ensures the flatness of the osteotomy surface, and achieves the purpose of precise osteotomy and rapid osteotomy.
进一步地，所述定位前臂的一端设置于所述滑轨内，通过限位梢与所述定位支架的另一端滑动连接。定位前臂和定位支架相适配互相滑动以实现卡合口大小的调整，当达到合适大小时，用限位梢将其位置固定，限位梢的两端都设有紧固件，该紧固件例如可以是但不限于螺帽、蝶形阀、橡胶或填充物。通过滑动微小距离调整所述第一套筒孔和第二套筒孔位置以精确确定两枚克氏针打入位置，从而得到免透视而确定精确截骨线的目的。Further, one end of the positioning forearm is disposed in the sliding rail, and is slidably connected to the other end of the positioning bracket through a limit pin. The positioning forearm and the positioning bracket are adapted to slide with each other to realize the adjustment of the size of the snap opening. When the appropriate size is reached, the position of the forearm is fixed with a limit pin. Both ends of the limit pin are provided with fasteners. The fasteners For example, it can be, but not limited to, a screw cap, butterfly valve, rubber or filler. The positions of the first sleeve hole and the second sleeve hole are adjusted by sliding a small distance to accurately determine the insertion positions of the two K-wires, so as to obtain the purpose of determining the precise osteotomy line without fluoroscopy.
进一步地，所述限位梢上设置有第一外螺纹，通过与其相适配的螺帽将所述定位支架的另一端和所述定位前臂的一端固定。这个常规结构一是被广大医者熟悉，操作简便，二是紧固效果好，不易产生松动脱落等现象。Further, the limiting pin is provided with a first external thread, and the other end of the positioning bracket and one end of the positioning forearm are fixed by a nut matched therewith. This conventional structure is familiar to the majority of doctors, easy to operate, and second, the fastening effect is good, and it is not easy to loose and fall off.
进一步地，在本发明所述的导向器使用的过程中，还需要配合为克氏针提供打入通道的套筒，套筒的数量为两个以上。所述导向器还包括第一套筒和第二套筒，所述第一套筒和第二套筒外部均设置有第二外螺纹和刻度标识，读出推进套筒后其上的刻度标识和圆弧半径就可测算出需打入的克氏针长度，这样可以大大降低医生和患者的射线暴露。更加优选的方案中，所述第一套筒、第二套筒与将打入的克氏针是相配套的，并且克氏针上也设置有刻度，这样在打入克氏针时，可以直接从远离针尖的一端刻度直接读出已钻入的克氏针长度。Further, in the process of using the guide according to the present invention, it is also necessary to cooperate with a sleeve that provides a driving channel for the K-wire, and the number of sleeves is more than two. The guide also includes a first sleeve and a second sleeve. The outside of the first sleeve and the second sleeve are provided with a second external thread and a scale mark, and the scale mark on the sleeve is read out after pushing the sleeve. And the radius of the arc can be used to calculate the length of the K-wire to be inserted, which can greatly reduce the radiation exposure of doctors and patients. In a more preferred solution, the first sleeve and the second sleeve are matched with the K-wires to be inserted, and the K-wires are also provided with scales, so that when the K-wires are inserted, the Directly read the length of the drilled K-wire directly from the end of the scale away from the needle tip.
在本发明的第二方面，发明人提供了一种如本发明第一方面所述的导向器在膝关节周围截骨中的导向应用。In the second aspect of the present invention, the inventor provides a guiding application of the guide according to the first aspect of the present invention in osteotomy around the knee joint.
优选地，所述导向应用包括将所述导板套在裸露在外的克氏针上的步骤。更具体地，导板套在克氏针上时，应注意将第一定位孔和第二定位孔对应地套在两根外露的克氏针上，更优选地可在限位通孔中打入克氏针以起到良好的固定作用。Preferably, the guiding application includes the step of wrapping the guiding plate over the exposed K-wires. More specifically, when the guide plate is sheathed on the K-wires, it should be noted that the first positioning hole and the second positioning hole are correspondingly sheathed on the two exposed K-wires. Kirschner wire for good fixation.
区别于现有技术，上述技术方案至少具有以下有益效果：Different from the prior art, the above technical solution at least has the following beneficial effects:
采用本发明所提供的用于膝关节周围截骨的导向器，只需要一到两次X 射线透射的辅助定位，就能够快速、精确地将2根克氏针钻入到理想截骨位置，并保证2根克氏针处于同一截骨面上。同时，本发明可以方便地为截骨锯导向并约束切割位置、方向和深度。另外，由于导板对克氏针的覆盖起到保护克氏针不随意松动移位，保证了截骨面的平整性，实现精准截骨和快速截骨目的，缩短手术时间，降低医生和患者暴露于X线的辐射伤害。By using the guide for osteotomy around the knee joint provided by the present invention, only one or two X-ray transmissions are needed for auxiliary positioning, and two Kirschner wires can be drilled into the ideal osteotomy position quickly and accurately. And ensure that the two Kirschner wires are on the same osteotomy surface. At the same time, the present invention can conveniently guide and constrain the cutting position, direction and depth for the osteotomy saw. In addition, because the guide plate covers the Kirschner wire to protect the Kirschner wire from loosening and shifting at will, it ensures the flatness of the osteotomy surface, realizes the purpose of precise osteotomy and rapid osteotomy, shortens the operation time, and reduces the exposure of doctors and patients. Radiation damage from X-rays.
附图说明Description of drawings
图1为具体实施方式所述一种用于膝关节周围截骨的定位导向器的定位器示意图；1 is a schematic diagram of a positioning guide for a positioning guide for osteotomy around the knee joint according to the specific embodiment;
图2为具体实施方式所述一种用于膝关节周围截骨的定位导向器的导板俯视图；2 is a top view of a guide plate of a positioning guide for osteotomy around the knee joint according to the specific embodiment;
图3为具体实施方式所述一种用于膝关节周围截骨的定位导向器的定位板剖面图；3 is a sectional view of a positioning plate of a positioning guide used for osteotomy around the knee joint according to the specific embodiment;
图4为具体实施方式所述一种用于膝关节周围截骨的定位导向器的限位板剖面图；4 is a sectional view of a limiting plate of a positioning guide for osteotomy around the knee joint according to the specific embodiment;
图5为具体实施方式中使定位前臂的一端与滑轨滑动连接的限位梢示意图；5 is a schematic diagram of a limit pin for slidingly connecting one end of the positioning forearm with the slide rail in the specific embodiment;
图6为具体实施方式中与限位梢的第一外螺纹适配的螺帽示意图。FIG. 6 is a schematic diagram of a nut adapted to the first external thread of the limiting pin in the specific embodiment.
附图标记说明：Description of reference numbers:
1、定位器；1. Locator;
101、定位底座；102、定位支架；1021、滑轨；103、定位前臂；104、定位后臂；105、定位杆；106、定位钩；107、限位梢；1071、第一外螺纹； 1072、螺帽；101, positioning base; 102, positioning bracket; 1021, slide rail; 103, positioning forearm; 104, positioning rear arm; 105, positioning rod; 106, positioning hook; 107, limit pin; 1071, first external thread; 1072 , nut;
11、第一套筒孔；12、第二套筒孔；11. The first sleeve hole; 12. The second sleeve hole;
2、导板；2. Guide plate;
21、定位板；21. Positioning plate;
211、第一面；212、第二面；213、第一侧面；214、第一定位孔；215、第二定位孔；211, the first surface; 212, the second surface; 213, the first side surface; 214, the first positioning hole; 215, the second positioning hole;
22、限位板；22. Limit plate;
221、第三面；222、第四面；223、第二侧面；224、限位通孔；2241、第一限位通孔；2242、第二限位通孔；221, the third side; 222, the fourth side; 223, the second side; 224, the limit through hole; 2241, the first limit through hole; 2242, the second limit through hole;
31、第一套筒；32、第二套筒。31. The first sleeve; 32. The second sleeve.
311、第二外螺纹；312、刻度标识。311, the second external thread; 312, the scale mark.
具体实施方式Detailed ways
为详细说明技术方案的技术内容、构造特征、所实现目的及效果，以下结合具体实施例并配合附图详予说明。应理解，这些实施例仅用于说明本申请而不用于限制本申请的范围。In order to describe in detail the technical content, structural features, achieved objectives and effects of the technical solution, the following detailed description is given in conjunction with specific embodiments and accompanying drawings. It should be understood that these examples are only used to illustrate the present application and not to limit the scope of the present application.
请参阅图1、2，本实施例提供一种用于膝关节周围截骨的导向器，由定位器1和导板2组成，所述定位器包括定位底座101、定位支架102、定位前臂103、定位后臂104、定位杆105和定位钩106。Referring to Figures 1 and 2, the present embodiment provides a guide for osteotomy around the knee joint, which consists of a
所述定位支架102的一端与所述定位底座(101)固定连接，所述定位支架102的另一端与所述定位前臂103的一端活动连接，所述定位前臂103的另一端与所述定位后臂104的一端固定连接，所述定位后臂104的另一端与所述定位杆105的一端固定连接，所述定位杆105的另一端与所述定位钩106 固定连接，其中，所述定位支架102的另一端上设置有滑轨1021，用于所述定位前臂103的一端与其滑动连接；这样随着所述定位器在不同部位的应用，可以将定位支架和定位前臂通过滑动调整卡合大小，适应不同部位骨头结构以及医生的操作。在不同的具体实施例中，定位支架和定位前臂可以是带有一定弧度的圆弧，也可以是直线段,当定位支架和定位前臂是相适配直线段的时候，定位支架、定位前臂、定位后臂和定位杆形成了“匚”字型，随着套筒的推进，使本发明导向器的定位器不断接近一个长方形、正方形或圆角长方形/正方形形态，此时通过长方形的宽或正方形的边长长度和推进的套筒长度就可以计算出需要打入的克氏针长度。当定位支架和定位前臂是相适配的圆弧的时候，套筒与定位底座的接触点到定位钩之间的距离即为圆弧的半径，通过滑动定位前臂调整定位器与待截骨位置的卡合，通过半径和推进套筒的长度计算出需要打入克氏针的长度。例如，在打入克氏针之前，在透视数据的指导下，将本实施例所述定位器1的定位底座(101)按已确定好的截骨线的位置摆放好第一套筒孔11和第二套筒孔12位置，将第一套筒31向胫骨方向推进，待第一套筒31刚好触及胫骨时，读出并记录已推进的第一套筒31 的深度，例如推进的深度为6cm，则根据定位支架102的半径(13-15cm)减去推进的第一套筒31深度得到第一套筒孔11中应打入的克氏针长度为(7-9) cm，以此类推可以测算第二套筒32中克氏针打入长度。此处已推进的第一套筒31的深度指的是第一套筒31的向前推进点到第一套筒31与定位底座(101) 远离推进方向边缘的交点之间的距离。One end of the
所述定位底座上沿着指向所述定位杆方向平行钻设有第一套筒孔11和第二套筒孔12。A
请参阅图3-4，所述导板2为由定位板21和限位板22通过手持端23连接形成具有槽体24的结构，所述定位板21设置有第一面211、第二面212和第一侧面213，所述限位板22设置有第三面221、第四面222和第二侧面223，所述第一面211和第二面212相对设置，所述第三面221和第四面222相对设置，所述第一侧面213和第二侧面223分别设置于远离所述槽体24的两侧，沿所述第一面211通向第二面212的方向平行开设有第一定位孔214和第二定位孔215，所述第一定位孔214和第二定位孔215中心轴线之间的距离与所述第一套筒孔11和第二套筒孔12中心轴线之间的距离相等。Please refer to FIGS. 3-4 , the
当打入两枚克氏针确定了截骨线之后，裸露在外的克氏针在后续的截骨操作中极易形成截骨障碍，并且在截骨过程中有发生移位的风险。因此，本发明提供的上述导板可以用第一定位孔214和第二定位孔215对应套在裸露的两枚克氏针上。并且，导板上的槽体24实际上为截骨操作提供了限位空间，指导截骨锯的截骨行进方向。所述槽体24沿所述第一侧面213通向第二侧面 223之间的距离为5-15mm。即槽体可供截骨锯活动的宽度为5-15mm。When two Kirschner wires are inserted to determine the osteotomy line, the exposed Kirschner wires can easily form an osteotomy obstacle in the subsequent osteotomy operation, and there is a risk of displacement during the osteotomy process. Therefore, the above-mentioned guide plate provided by the present invention can be correspondingly sleeved on the two exposed K-wires by the
为了使套在裸露的克氏针上的导板形成更稳定的结构，在限位板上沿所述第三面221通向第四面222的方向开设有1个以上的限位通孔224，用于打入限位克氏针。在更加优选的实施方式中，为了增强导板稳定性，防止在截骨过程发生不期望的移位、松动等情况，所述限位通孔包括第一限位通孔2241 和第二限位通孔2242，并且所述第一限位通孔2241和第二限位通孔2242不平行设置。In order to form a more stable structure for the guide plate sheathed on the exposed Kirschner wire, more than one limit through
请参阅图5-6，所述定位支架102的另一端与所述定位前臂103的一端活动连接，这种活动连接可以是卡接、旋接或套接等常见活动连接方式。更进一步地，所述定位前臂103的一端设置于所述滑轨1021内，通过限位梢107 与所述定位支架102的另一端滑动连接。由于所述定位支架102和定位前臂之间可以互相滑动调节距离以有利于将该定位器适用于具有不同尺寸的胫骨截骨术或其他部位截骨术中。更加优选的，所述限位梢107上设置有第一外螺纹1071，通过与其相适配的螺帽1072将所述定位支架102的另一端和所述定位前臂103的一端固定。Referring to FIGS. 5-6 , the other end of the
更加优选的，所述导向器还包括第一套筒31和第二套筒32，所述第一套筒31和第二套筒32外部均设置有第二外螺纹311和刻度标识312。More preferably, the guide further includes a
本发明提供的导向器在应用时具体操作包括打入两枚克氏针确定截骨线后，再将所述导板套在裸露在外的克氏针上，这样，就避免了截骨锯在推进过程中可能发生的克氏针移位、松动或截骨面偏移的情况发生。The specific operation of the guide provided by the present invention includes driving two Kirschner wires to determine the osteotomy line, and then covering the guide plate on the exposed Kirschner wires, so as to avoid the osteotomy saw from advancing Displacement, loosening or displacement of the osteotomy surface may occur during the procedure.
本发明提供的定位导向器仅需在两次透视指导下就可方便快速地确定截骨线，并能使操作该截骨术的医生精准地在无透视下打入克氏针，同时避免了在截骨过程中克氏针发生移位、松动、截骨面倾斜以及反复透视的困扰。本发明提供的定位导向器适用于膝关节周围截骨术中包括胫骨近端高位截骨和股骨远端截骨。通过定位支架可以准确将克氏针打入到合页位置(胫骨近端高位截骨合页位置位于腓骨尖端上三分之一，股骨远端截骨合页位置位于干骺端交叉点)，通过套筒上刻度，支架半径，可以计算出需要截骨的深度，然后将截骨导板套入克氏针，就可以确定截骨方向、深度，保证截骨面的平整性，实现精准截骨和快速截骨目的。整个操作简单，方便，容易在临床上推广。The positioning guide provided by the invention can conveniently and quickly determine the osteotomy line only under the guidance of two fluoroscopy, and enables the doctor operating the osteotomy to accurately insert the Kirschner wire without fluoroscopy, while avoiding the need for fluoroscopy. During the osteotomy process, the Kirschner wire is displaced, loosened, the osteotomy surface is inclined, and the trouble of repeated fluoroscopy. The positioning guide provided by the present invention is suitable for the osteotomy around the knee joint, including the high osteotomy of the proximal tibia and the osteotomy of the distal femur. The Kirschner wire can be accurately driven into the hinge position by positioning the bracket (the proximal tibial high osteotomy hinge position is located in the upper third of the tip of the fibula, and the distal femoral osteotomy hinge position is located at the metaphyseal junction), Through the scale on the sleeve and the radius of the bracket, the depth of the osteotomy can be calculated, and then the osteotomy guide plate is inserted into the Kirschner wire to determine the direction and depth of the osteotomy, ensure the flatness of the osteotomy surface, and achieve accurate osteotomy and rapid osteotomy purposes. The whole operation is simple, convenient and easy to popularize in clinic.
需要说明的是，尽管在本文中已经对上述各实施例进行了描述，但并非因此限制本发明的专利保护范围。因此，基于本发明的创新理念，对本文所述实施例进行的变更和修改，或利用本发明说明书及附图内容所作的等效结构或等效流程变换，直接或间接地将以上技术方案运用在其他相关的技术领域，均包括在本发明的专利保护范围之内。It should be noted that, although the above embodiments have been described herein, it does not limit the scope of the patent protection of the present invention. Therefore, based on the innovative concept of the present invention, changes and modifications to the embodiments described herein, or equivalent structures or equivalent process transformations made by using the contents of the description and drawings of the present invention, directly or indirectly apply the above technical solutions In other related technical fields, all are included within the scope of patent protection of the present invention.
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| CN102335033B (en)* | 2011-07-01 | 2013-06-19 | 白石柱 | Individual craniofacial bone piece auxiliary positioning guide plate system and preparation method thereof |
| CN104000634B (en)* | 2014-06-16 | 2016-01-13 | 南通舟可信息科技有限公司 | A kind of combination unit of interotrochanteric osteotomy and using method thereof |
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| CA1193509A (en)* | 1982-05-20 | 1985-09-17 | Douglas B. Mains | Tibial osteotomy guide assembly and method |
| CN101155559A (en)* | 2005-02-08 | 2008-04-02 | I平衡医疗公司 | Method and apparatus for forming a wedge-like opening in a bone for an open wedge osteotomy |
| CN207721848U (en)* | 2017-04-28 | 2018-08-14 | 首都医科大学宣武医院 | A cut bone baffle for high-order osteotomy of shin bone |
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